Court Copies Request Form {CW-9023}

SUPERIOR COURT OF CALIFORNIA COUNTY OF SANTA CLARA Complete information below: Name: Address: City: Day Phone: State: Fax#: Zip: Date: Case number or year case number started: Case Name: Qty Preparing copies of any record (per page) ........................................... Certifying a dissolution of marriage in addition to the copying fee ....... A search fee is required if you are unable to provide all of the following information: ............................................................................ · Case number · Case name · Title of document(s) · Date document(s) filed ........................................................... Exemplification of a record (Government Cod 26839) ........................ Fax requests (first page/additional pages) .......................................... Unit Price $ .50 Total $25.00 $15.00 $15.00 $20.00 $3.00/1.00 TOTAL Document(s) requested: Date of Transaction: HP Confirmation#: ***THERE IS A TRANSFER FEE OF $5.95 TO PROCESS PAYMENT BY CREDIT CARD** (Please advise customer of this charge) CREDIT CARD: Cardholder's Name: Expiration Date: Verification Number: VISA MASTERCARD AMERICAN EXPRESS Card Number: Zip Code: Denied DISCOVER CW-9023 REV 6/24/15 American LegalNet, Inc. www.FormsWorkFlow.com